1. Showcase: Personalised Commissioning in Cheshire West

2. Content Personalised Commissioning Case for change Universal model
Our Care Communities
Personalised Commissioning in our Care Communities
Case study 1: Community Independent Living Advisor
Case Study 2: Personal Wheelchair Budgets
Case Study 3: Complex Care
Voluntary Sector as equal partners
Involving patients and the public
Successes to date
Next steps

3. Personalised Commissioning
A personalised approach to care will:
Improve people’s health and wellbeing outcomes and experience of care, through involving them more fully in designing support around their individual needs and circumstances;
Prevent crises in people’s lives that lead to unplanned hospital and institutional care through supporting effective self-management
Deliver improved value for the health and care system through quality improvements, better integration of care and reductions in demand and cost.
Personalised care incorporates:
whole population approaches to supporting people of all ages, and their carers, regardless of condition, to manage their physical and mental health and wellbeing and make informed choices and decisions when their health changes;
a proactive and universal offer of support to people with long term physical and mental health conditions to build knowledge, skills and confidence leading to improved ability to self-manage and build community capacity. This means that as well as providing appropriate medical care, services work with people to find ways of meeting their own needs, and the needs of others, in the place where they live.
Intensive approaches to empowering people with more complex needs to have greater choice and control over the care they receive.

4. Case for change
Next Steps on the Five Year Forward View has brought added impetus to the need to roll out personalised care across England to realise the significant contribution this can make to meet the triple aim of improved health and wellbeing, better care and greater value for the public pound.
Personalised care means people having choice and control over decisions that affect their health and wellbeing. A person receiving personalised care is at the centre of the way that care is planned and delivered, based on individual needs, preferences and priorities. Health and care services that provide personalised care recognise the expertise, capacity and potential people, carers, families and communities bring to managing health and wellbeing. They all work together as equal partners to deliver better outcomes for people and reduce health inequalities.
Health and care services must be transformed to address demographic and financial pressures, technological advances and changing attitudes. Personalised Care provides a proactive and holistic approach to healthcare transformation, involving greater engagement with people and communities. It has a key part to play in securing the sustainability of NHS and other care services.
The vision is that in the future, people should expect the same focus on their independence, the same regard for their wishes and the same opportunities to make choices and take control, whether they have a long term physical or mental health condition, a complex need, or are making a decision about particular care or treatment, such as maternity services or at the end of life.

5. Continuing Health Care, Complex Care (including section 117)
Universal Model
Integrated contract for arrangement of care and support for personal (health) budgets across Cheshire, Wirral and Warrington
Integrated contract for arrangement of carers support
Personal Wheelchair Budgets, Patient Activation Measures, Diabetes Care
Community Independent Living Advisor, Health & Wellbeing Co-ordinator

6. Our Care Communities
Care Communities across Cheshire West will provide enhanced care through truly integrated working across the system. This will require a culture shift to enable care community teams to focus on empowering people to drive their own wellness and optimal outcomes. There will be a shift in resources and focus from high to low acuity, from bed-based to home-based, and from professionally directed, to individually directed care.

7. Personalised Commissioning in our Care Communities
Personal (Health) Budgets and integrated budgets
Person-centred care and support planning
Self management and health education
Patient activation tools
Social prescribing and community connecting

8. Universal Care
In 2018/19 the population of Cheshire West will have access to;
Social prescribing through work with Voluntary Sector
Personal Maternity Budgets
Early Intervention Prevention pathfinding

9. Targeted Care
In 2018/19 people with Long Term Conditions and low level Mental Health issues in Cheshire West will have access to;
Personal Wheelchair Budgets
Patient Activation tools
Self management and health education, e.g. Diabetes Essentials
Year of Care approach for primary care reviews
Support planning and enhanced community connecting through a ‘Community Independent Living Advisor’ (CILA) and health and wellbeing co-ordination

10. Specialist Care
In 2018/19 people with highly specialist complex needs in Cheshire West will have access to;
Personal Health Budgets through Continuing Health Care, Complex Care (Learning Disabilities and Mental Health) and Continuing Care (children)
Fast track access to Personal Health Budgets
Integrated budgets through Section 117 aftercare packages

11. Case Study 1: Community Independent Living Advisor (CILA)
The Community Independent Living Advisor (CILA) aims to bridge the gap between the local Care Communities and the Third Sector in order to offer a more person centred approach to local care delivery. The CILA will work with people to achieve their health and social care outcomes in a way that takes an asset based approach  to  make best use of local resources.
We have worked with statutory and voluntary sector partners to ensure that the CILA role can be embedded into the statutory team. This work also forms part of the Neighbourhood Care pilot which has a number of personalised commissioning elements throughout, some of which are to be rolled out across our Care Communities.
“Mrs. Smith cares for her husband who has a long-term health condition. She was referred to the Community Independent Living Advisor (CILA) as she had become increasingly depressed and felt that she could not longer cope in her caring role. As a result of the work with the Community Independent Living Advisor, Mrs. Smith is slowly coming to terms with having so many opportunities and says she feels so much better knowing that she has choices.”
Person and/or family are known to community team
Anybody can make a referral to the CILA to initial advice and support
CILA will gather information known about the person with their permission
Person receives visit
CILA will visit the person to understand their outcomes and complete a person centred support plan (and PAM measure) where appropriate
Implementation
CILA will work with the family to implement the support detailed in their plan through traditional and creative avenues of support
CILA will support person to access a personal (health) budget and other funding if appropriate
Review
CILA will review the persons support plan with them periodically to ensure they continue to meet their stated and agreed outcomes.

12. Case Study 2: Personal Wheelchair Budgets
By implementing Personal Wheelchair Budgets (PWBs) we aim to offer people more choice and control over their choice of chair and how it is provided to best meet their needs.
Partners are working closely with local charities and patient groups to provide the best possible of to people in Cheshire West.
“By using a personal wheelchair budget and ‘Access to Work’ funding together, I am able to purchase a chair which provides me with more maneuverability in tight environments such as the office I will be working in and improved access in getting on/off the bus”
Pre-appointment
Information about PWBs sent with appointment
Information in waiting area promoting PWBs
Assessment Appointment
Clinical assessment
Develop a personal support plan
Discuss and agree health and well- being outcomes
Offered PWB (this is default position)
Informed of wheelchair prescription and PWB value
Assist patient in deciding which PWB option to choose
Handover
Wherever possible, wheelchair handed over on same day
Person always returns for handover if they opt for 3rd party budget
Person instructed in safe use of wheelchair
The person has open access to the service for clinical advice

13. Case Study 3: Continuing Health Care and Complex Care
We aim to provide all people accessing Continuing Health Care, Complex Care or Continuing Care in the community with a Personal Health Budget.
We are working closely with partners, including strong contracting arrangements with the voluntary sector to ensure that local people experience joined-up, person-centred support when accessing Personal (health) Budgets.
“What I can say at this early stage is that the support we have received has been invaluable., the keenness to understand what was important to us and explaining how and what support is available to manage a PHB has all been a positive one.  It feels, at the moment that we have the benefit and freedom of a PHB without the hassles of administrating it, and that meets Mum's need through the fact that she has a personalised package of care, and meets my need as her main carer with my own family and full-time job.”
Person eligible for CHC, CC in the community
Discuss PHB by default position
Arrange for eligibility letter to be sent
Person requests notional care
Complete national support plan with person
Update system to reflect package and commission using DPS
Ensure that system reflects PHB-notional status
Person would like independent support
Person may request 'non traditional' care, PA or respite, direct payment, managed account, agency not on DPS, community resources or independent support with person centred plan
Refer to Arrangement of Care &Support service with agreed budget
Support plan will be completed and returned to operational team
Approve and load onto Broadcare ensuring to update the PHB status

14. Voluntary Sector as equal partners
Circa £2m system-wide investment in Voluntary Sector services for
Strong engagement through existing mechanisms
Development of new networks based around our Care Communities in 2018/19

15. Working with local people
The Personalised Commissioning Co-production group meets monthly to develop pieces of work in line with their terms of reference
We are supporting them to gain knowledge, skills and confidence around the system and personalised commissioning and in return they are offering their expertise as patients in the pathways we are developing.

16. Successes to date
Joint Arrangement of Care and Support contract (6CCG partners plus 1 LA, with option for 2 more to join)
West Cheshire has increased its personal health budget numbers by 497% over the past 10 months 
“We are delighted in how you have progressed so quickly and with such focus on improving outcomes for the people who access wheelchair services in West Cheshire. To have implemented across the whole service and be already building a repository of case studies where you have improved outcomes for people cost effectively, is a credit to you by being agile and personalised in your approach to this project. I am looking forward to showcasing your hard work to other Clinical Commissioning Group’s and hopefully we will be able to support you to be mentors to other areas who are looking to develop their personal wheelchair budget offer locally.”
“The programme has made significant progress in the last 9-12 months across a number of key areas in the Personalised Commissioning Model. For example excellent progress has been made in developing a comprehensive and innovative offer around personal wheelchair budgets, developing work with local area or neighbourhood teams to extend the IPC model into primary care, enabling and embedding personalised care and support planning through the work of the CILA and making connections locally to help access peer support from community and VCSE groups.”
Kate Buffery - Senior Programme Manager Personalisation Wheelchair Services, NHS England
Alix Crawford, NHS England Site Lead, Integrated Personal Commissioning Programme

17. Next Steps
To ensure that the ‘default’ Personal Health Budget option is fully integrated within Continuing Healthcare and Complex Care working practice
To work specifically with local people who access support through ‘Section 117 Aftercare’ to further personalise their care and support pathways
To further enhance our (advanced) care planning with our older population
To evaluate the effectiveness of the Community Independent Living Advisor role with a view to rolling out further across our Care Communities
To ensure that Personalised Commissioning is a golden thread through our Integrated Care Partnership work.